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Relationship between LAAM-methadone preference and treatment outcomes
Jason M White1, Cath Danz, Joanne Kneebone
1Department of Clinical and Experimental Pharmacology, Adelaide University, SA 5005, Australia. jason.white@adelaide.edu.au
Drug and Alcohol Dependence
|June 14, 2002
Summary
Patients preferring levo-alpha-acetylmethadol (LAAM) over methadone in opioid treatment experienced better outcomes. LAAM preference was linked to reduced heroin use and improved vitality and mental health, suggesting it may be a superior option for some individuals.
Area of Science:
- Addiction Medicine
- Pharmacology
- Clinical Trials
Background:
- A significant proportion of patients express a preference for levo-alpha-acetylmethadol (LAAM) over methadone.
- Previous studies indicate patient preference for LAAM, but its impact on treatment outcomes requires further investigation.
Purpose of the Study:
- To determine if patient preference for LAAM is associated with improved treatment outcomes compared to methadone.
- To evaluate the comparative effectiveness of LAAM and methadone maintenance in stable opioid-dependent patients.
Main Methods:
- A randomized crossover clinical trial involving 62 stable methadone patients.
- Patients received LAAM (alternate days) and methadone (daily) for 3 months each, followed by a 6-month choice period.
- Outcomes assessed included heroin use (via hair analysis), SF-36 health outcomes, and patient-reported reasons for drug preference.
Main Results:
- LAAM maintenance was associated with a lower rate of heroin use compared to methadone maintenance.
- A majority of subjects (69.2%) preferred LAAM, citing less withdrawal, fewer side effects, reduced craving, and fewer pick-up days.
- Patients preferring LAAM showed better outcomes in Vitality and Mental Health sub-scales of the SF-36 and reported feeling more 'normal' and 'held'.
Conclusions:
- Preference for LAAM in opioid maintenance treatment is associated with comparable or better treatment outcomes than methadone.
- LAAM may offer advantages in reducing heroin use, improving psychological well-being, and enhancing patient quality of life.
- Individual patient preference should be considered in optimizing opioid substitution therapy.